Provider Demographics
NPI:1841266327
Name:GRONDIN, MARYLYN VIRGINIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARYLYN
Middle Name:VIRGINIA
Last Name:GRONDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21 CLARK WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-4401
Mailing Address - Country:US
Mailing Address - Phone:603-692-2228
Mailing Address - Fax:603-692-0437
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-433-2488
Practice Address - Fax:603-433-4649
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH8703207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE29106Medicare UPIN
NHNH3885Medicare PIN